Individual
JAN HULTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3909 SE HOLGATE BLVD, PORTLAND, OR 97202-3143
(503) 206-5314
Mailing address
3909 SE HOLGATE BLVD, PORTLAND, OR 97202-3143
(503) 206-5314
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0011000
OR
Other
Enumeration date
09/23/2009
Last updated
09/23/2009
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